Achilles Tendon Rupture

The Achilles tendon attaches the calf muscles to the heel bone (calcaneus). Unfortunately, it is prone to rupture most commonly in middle-aged part-time sports men and women. Achilles tendon ruptures can be managed with or without surgery. Surgical reconstruction of Achilles tendon ruptures tends to result in a lower re-rupture rate and a faster return to activity. The decision to have surgery or otherwise should involve an in-depth conversation about the pros and cons of each.

Achilles tendon surgery involves:

• General anaesthetic, intravenous antibiotics
• 7 cm long incision over the area of tendon rupture
• Repair of tendon rupture
• Closure of sheath around tendon
• Wound closure
• Front slab/cast

All surgical procedures carry some risk. Fortunately the risk of complications with Achilles tendon repair is relatively low. Some of the risks of surgery include:

• Infection
• Problems with wound healing
• Nerve injury causing numbness, tingling and/or pins and needles
• Deep venous thrombosis/pulmonary embolism (the risk of DVT increases with smoking, the oral contraceptive pill and hormone replacement therapy, immobility and obesity)
• Anaesthetic complications
• Drug allergy
• Ongoing pain
• Re-rupture (this is most uncommon)

Rest - You will have a cast on your leg. Keep foot elevated as much as possible, especially for initial 72 hours. Keep dressings dry and intact until post operative appointment. - Mobilise short distances as pain allows, aim to remain in your own home for the first few weeks limiting long periods of standing or mobilising - Do not bear weight for the first two weeks

Pain - Pain relief may be required for up to 2 weeks; depending on your other medications this may include: - Regular paracetamol, anti-inflammatory drugs and break through opiate type medications - A regular blood thinning medication will also be prescribed for 6 weeks

Driving - Any surgery performed on the right foot or both feet will mean no driving for a minimum of 6 weeks - If surgery was performed on the left foot then driving in an automatic is possible, but Dr Phegan would recommend waiting a minimum of two weeks before attempting to drive

Driving any vehicle with a cast or boot is potentially hazardous and you should consider this before getting behind the wheel.

Follow up - Keep all dressings dry and intact for the first two weeks - Removal of stitches/sutures typically occurs at an appointment with Dr Phegan and his in-house therapists at 10-14 days at first post operative appointment. Very occasionally some sutures need to stay in for longer - Your appointment will be booked by Dr Phegan and a confirmatory SMS will be sent informing you of the time and date for follow up

Typical milestones - 2 weeks: Wound review and removal of sutures, change from cast to boot, commence dynamic rehabilitation protocol - 2-6 weeks: regular physiotherapy to increase range and weight bearing as per the protocol - 6 weeks to 3 months: work on swelling reduction, scar massage and mobility - Full recovery 3-6 months

Every patient's recovery is individual and depends on the severity of the injury and the complexity of the surgery.